NPIMap

Individual provider Active NPI

Milan Jordan, MD

  • Vascular Surgery Physician
  • Manitowoc, WI
National Provider Identifier
1649264441
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
32315 Issued in WI
Practice address
2300 Western Ave
Manitowoc, WI 54220-3712
Phone
(920) 320-3165
Fax
(930) 320-3169
NPI assigned
Sep 7, 2005
Last updated
Nov 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 32315 WI Primary

Addresses

Primary practice location

2300 Western Ave
Manitowoc, WI 54220-3712

Mailing address

PO Box 2290
Manitowoc, WI 54221-2290
Phone (920) 320-2591

Other identifiers 2

IdentifierTypeStateIssuer
208600000XMedicaidWI
34516300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040803000179 WI Practitioner - Vascular SurgeryPractitioner - General Surgery 2769453992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
R Franklin University of Med & Sci/Chicago Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Froedtert Manitowoc Medical Group, LLCGroup PAC ID 2365836954, 156 clinicians

Practice addresses (Care Compare)

1414 N Taylor Dr
Sheboygan, WI 53081-1988
Phone (920) 320-2436

2300 Western Ave
Manitowoc, WI 54220-3712
Phone (920) 320-2011

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Varicose vein removal1-10
Leg revascularization (restoring blood flow)1-10
Removal of tissue23
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Apr 17, 2025 Accepting new patients
Thedacare, Incorporated CurrentSince Apr 17, 2025 Accepting new patients
Froedtert Manitowoc Medical Group, LLC CurrentSince Apr 2, 2022 Accepting new patients
Mercy Medical Center of Oshkosh, Inc. Past Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc Past Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc PastSince Mar 19, 2023 Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

1650 S 41st St
Manitowoc, WI 54220
Phone (920) 320-3100

2300 Western Ave
Manitowoc, WI 54220
Phone (920) 320-2011

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

1414 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 320-2011

Interoperability endpoints

  • Direct secure messaging: mjordan153387@direct.froedtert.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Froedtert Holy Family Memorial HospitalManitowoc, WI, CCN 520107 Hospital Corporate Director Oct 1, 2024
Froedtert Holy Family Memorial Home CareManitowoc, WI, CCN 527154 Home health agency Corporate Director Oct 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322438400000",
    "number": "1649264441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2290",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542212290",
            "telephone_number": "920-320-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 WESTERN AVE",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542203712",
            "telephone_number": "920-320-3165",
            "fax_number": "930-320-3169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MILAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2011-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WI",
            "license": "32315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208600000X",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34516300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manitowoc, WI

Sources for this page

Verify at the official NPI Registry.